Vision impairment can occur for many reasons, and be the result of many causes. One, all too common, cause for vision impairment results from a defective condition of the eye which occurs when the refractive characteristics of the cornea do not cause parallel rays of light to focus on the retina. When the eye is at rest, and the rays of light focus in front of the retina, the condition is known as myopia (i.e. near-sightedness). On the other hand, when the rays of light focus behind the retina, the condition is known as hypermetropia or hyperopia (i.e. farsightedness). Both myopic and hyperopic conditions result in varying degrees of vision impairment and, as is well known, in most cases the conditions are correctable.
Spectacles or eyeglasses are commonly used to correct myopic or hyperopic conditions. For various reasons, however, many persons who suffer with these conditions prefer not to wear eyeglasses. Fortunately for these individuals, it is known that surgical procedures can be employed which will reshape the cornea in ways that are effective in changing its refractive characteristics. For example, U.S. Pat. No. 4,665,913 which issued to L'Esperance for an invention entitled "Method for Ophthalmological Surgery", and U.S. Pat. No. 4,669,466 which issued to L'Esperance for an invention entitled "Method and Apparatus for Analysis and correction of Abnormal Refractive Errors of the Eye" both disclose a laser system which photoablates corneal tissue from the anterior surface of the eye. In a different manner, U.S. Pat. No. 4,988,348 which issued to Bille for an invention entitled "Method for Reshaping the Cornea", and which is assigned to the same assignee as the present invention, discloses a procedure whereby corneal tissue is first removed to correct vision, and then the newly created surface is smoothed.
Rather than remove and reshape portions of the anterior portion of the eye to correct refractive defects, some procedures for reshaping the cornea have suggested intrastromal photoablation for removal of only stromal tissue. As an example of such a procedure, U.S. Pat. No. 4,907,586, which issued to Bille et al. for an invention entitled "Method for Reshaping the Eye" discloses an intrastromal photodisruption technique for reshaping the cornea. Another example of a procedure which is intended to essentially remove only stromal tissue is the so-called "flap and zap" procedure. For this procedure, an anterior portion of the cornea is removed and a portion of the exposed stroma is then photoablated. The previously removed anterior portion of the cornea is then repositioned on the cornea to cover the photodisruption. This procedure, like the procedure disclosed in Bille et al. '586, has as its objective the removal of only stromal tissue with the consequent preservation of anterior corneal tissue. A significant downside for the "flap and zap" procedure, however, is the possibility that the previously removed anterior portion of the cornea may again become detached. While the intrastromal procedure disclosed by Bille et al. does not lead to this detachment problem it can, in some cases, require extensive laser photodisruption and be time consuming.
In one aspect, it is appreciated by the present invention that the "flap and zap" procedure can be made more effective and efficient if the "flap" that is created can somehow be repositioned in an interlocking relationship with the undisturbed corneal tissue. To accomplish this, the present invention recognizes that it would be desirable if, first, a "flap" with an interlockable configuration is created. The flap could then be lifted to expose the corneal tissue that is to be removed and, next, after the desired amount of corneal tissue is removed, the flap could be repositioned and interlocked with undisturbed corneal tissue to hold the "flap" in place during the healing process.
The use of laser systems for ophthalmic surgical procedures, such as for other procedures contemplated for the present invention, is particularly appropriate due to the extreme precision required when corneal tissue is to be removed. Specifically, depending on the diameter and the general shape of the tissue volume to be removed, it is known that the removal of a layer of stromal tissue which is only approximately ten microns thick will result in a one diopter change. More practically, by way of example, the removal of a lens shaped volume of tissue which is four millimeters in diameter and approximately fifty microns thick at its center will result in a refractive correction of approximately four diopters. In almost all cases, for precise vision corrections which can stay within a one diopter accuracy, the surgical procedure employed must be capable of removing corneal tissue having a thickness which is accurate to within less than ten microns. Furthermore, this degree of accuracy applies for any refractive correction regardless of the total amount of correction required.
It happens that the correction of myopia requires removal of a differently shaped volume of corneal tissue than does the correction of hyperopia. Also, the limits of potential correction are different. Specifically, for a myopic correction it is known that a lentoid or lens shaped volume of stromal tissue needs to be removed. At the present time, myopic corrections of up to approximately thirty diopters can be reasonably expected. On the other hand, corrections of hyperopic conditions can be made up to only about fifteen diopters. Furthermore, for a hyperopic correction a generally doughnut shaped volume of stromal tissue, rather than a lens or lentoid shaped volume, needs to be removed.
In light of the above, it is an object of the present invention, to provide a method for corneal laser surgery which corrects the refractive characteristics of the cornea by removing only stromal tissue with minimal photodisruption of the tissue. Another object of the present invention is to provide a method for corneal laser surgery which essentially maintains the structural integrity of corneal tissue. Still another object of the present invention is to provide a method for corneal laser surgery which can be accomplished with a high level of precision when cutting corneal tissue by photodisruption. Another object of the present invention is to provide a method for corneal laser surgery which creates an interlocking flap that can be lifted to remove a predetermined volume of tissue from the stroma and then repositioned in an interlocking relationship with undisturbed corneal tissue to hold the flap in place during subsequent healing. Yet another object of the present invention is to provide a method for corneal laser surgery which is relatively easy to practice and comparatively cost effective.